Time limit for Medicaid? Official doubts four-year cap

LANSING (AP) – The Snyder administration’s top health official on Friday was both receptive to and critical of Republican lawmakers’ alternative plan to make more low-income uninsured adults eligible for Medicaid, expressing confidence that a deal will be reached within a month.

State Department of Community Health Director James Haveman told The Associated Press he is a “glass half-full guy” despite having concerns with the legality of a proposed four-year cap on health insurance for nondisabled adults. About 375,000 such adults are covered now in Michigan, and 320,000 more would qualify in 2014 if Medicaid is expanded.

Haveman said some of them are chronically ill.

“All the logic would tell you that we got to do something for these people,” he said in an interview a day after House Republicans unveiled their Medicaid expansion legislation. “We just can’t continue with this number of people uninsured. It’s all coming down to what the program looks like.”

Medicaid covers roughly one in five Michigan residents – mainly low-income children, pregnant women and the disabled along with some poorer working adults.

Haveman said the administration has concerns with putting a time limit on insuring low-income adults, but he does not want to overreact and called it a starting point. The 48-month Medicaid cap was touted by Republican House Speaker Jase Bolger Thursday as the first such proposal in the country, one designed to give a temporary safety net to more able-bodied adults in hard times.

Critics say many people are working full-time but not making enough to buy their own insurance without government aid.

Time limits are more common with cash assistance, and Haveman said he has not talked to the federal Centers for Medicare & Medicaid Services about the idea.

“Is it legal or not? That’s what it will come down to. It wasn’t in the governor’s recommendation,” he said, later saying he does not see the four-year cap as a “poison pill” that could thwart Medicaid expansion.

Haveman pointed to positives in the plan, such as incentivizing healthy living among nondisabled adults, making them pay premiums or copays and creating individual health savings accounts.

“Our belief is (our) plan was a pretty good plan. But I do like the personal engagement that’s in this bill. I think there’s a lot in this bill we can work with,” Haveman said.

House hearings on the legislation will begin next week.

Haveman said he understands legislators’ desire to make recipients more personally responsible for their care and to revisit Medicaid expansion when the federal government stops covering the entire cost of expansion in the future.

The federal health care law allows states to expand Medicaid to adults making up to 133 percent of the poverty level, about $15,300 for an individual. Republicans who control the Legislature have resisted GOP Gov. Rick Snyder’s call to expand the program, but have been more open if changes are made at the state level.

The U.S. government would need to grant a waiver for Michigan to proceed with changes included in the House bill.

Working parents in Michigan currently qualify for the taxpayer-funded insurance if they earn up to about half the poverty line, $11,800 for a family of four. Nondisabled adults without children who make less than 35 percent of the poverty level, or $4,000 for an individual, also get Medicaid – though the program generally is closed to new participants.

An estimated 320,000 state residents – many of them adults without children – could be added to Medicaid in 2014 and 470,000 by 2021, cutting the state’s uninsured by nearly half. Uninsured with higher incomes will be covered by a federal insurance marketplace offering taxpayer-subsidized private plans.

“Many of them are working in $8 to $10 to $12 an hour jobs,” Haveman said of those covered if Michigan expands Medicaid eligibility. “They don’t have health care. So when they do need health care, they go to the ER room or don’t get it or they wait until they got stage 4 cancer. So we know we can do a better preventive job for those folks.”